Chihuahua Rescue of Georgia Dog Adoption Application

Please fill in the following information and click on the submit button at the bottom of the page if you are interested in adopting a pet from Chihuahua Rescue of Georgia. Please note that Chihuahua Rescue of Georgia rescue groups do NOT adopt outside of Georgia, and some rescue groups will not adopt outside of the Atlanta area. It may take up to 3 days to get a response from Chihuahua Rescue of Georgia regarding this application, so please be patient. Most responses are initially via e-mail, so be sure your e-mail address is accurate below, and be sure to check your e-mail for a reply from us.

Chihuahua Rescue of Georgia reserves the right to refuse any applicant.

Applicant:
First Name: Last Name: Age: Occupation:
Co-applicant (Spouse or Significant Other):
First Name: Last Name: Age: Occupation:
Street address:
City: County: State: ZIP:
Home Phone: Work Phone:
E-mail (required field):

What is the name of the foster home and the dog/breed you are interested in?

List any general questions you would like to ask about this particular dog:

Are you willing to allow a representative from Pet Orphans Rescue to visit your home by appointment? Yes No
Please check any of the following reasons for adopting this dog:  family pet  child's pet  watchdog  companion  hunting dog  guard dog for business  companion for other pet  gift  other - please specify:
Please indicate where you live: apartment house condo/townhouse trailer/mobilehome
Do you...  rent home own home
If you rent, do you have the landlord's permission to own a dog? Yes No
      What is the apartment complex name?
      What is the landlord's phone number?
      How much is the pet deposit? $
How many times have you moved in the past 5 years? times
If you move, will your pet go with you? Yes No
Would you ever consider moving somewhere that doesn't allow your pets? Yes No
Do you foresee any major changes in your life in the next 15 years (average lifespan of a dog) such as marriage, childbirth, health problemsdue to age, going away to college? Yes No
If yes, please explain:
Do you or anyone in your household currently have any serious health problems? Yes No
If so, please describe:
Can you provide a permanent home for this dog for 10-15 years? Yes No
Do you have a fully fenced yard with no fence gaps?  Yes No
If yes, how high and what kind? 
If no, would you consider fencing all or part of it as a condition of adopting a dog? Yes No
Number of adults in household?
Relationship(s):  spouse  roommate(s)  life partner  other - please specify:
Does anyone in the household smoke? Yes No
Will this dog be a surprise for any family members? Yes No
If yes, who?
Do any family members have allergies? Yes No
Do any children live in the house? Yes No
If so, what are their gender/ages?
Number, type and age of pets currently in household?
Do any of your current or did any of your past pets live primarily outdoors? Yes No
If yes, please describe pet:
Were all previous pets spayed/neutered? Yes No
Are all current pets spayed/neutered? Yes No
Do you know what heartworm disease is and how to prevent it? Yes No
Is your current dog or was your previous dog on heartworm prevention medication? Yes No
If yes, how often do/did you give the heartworm medication? What brand do/did you use?
What is your veterinarian's name and phone number?
What do you expect annual pet care (vet care, medication, heartworm preventative, etc.) to cost yearly?   $
How many dogs have you owned in the past?
If any, please describe what happened to each of them (put to sleep, run over, died of old age, sold, given away, ran away, etc.)
Who will be responsible for the daily care and training of your new dog?
How do you plan to prevent fleas and ticks?
Are you aware of Frontline or Advantage? Yes No
How many hours will the dog be home alone on a typical day?
Where does your current dog stay when home alone during the day? outside in fenced area outside in dog pen outside on chain or tie-out inside in basement in the garage inside free run of house inside in one room of house inside in crate; other, please describe:
Where will your new dog stay when home alone during the day? outside in fenced area outside in dog pen outside on chain or tie-out inside in basement in the garage inside free run of house inside in one room of house inside in crate; other, please describe:
Where do current pets sleep at night? dog house in fenced area dog house in dog pen dog house near tie-out inside in basement in the garage inside free run of house inside in one room of house inside in crate in my bed; other, please describe:
Where will the new dog sleep at night? dog house in fenced area dog house in dog pen dog house near tie-out inside in basement in the garage inside free run of house inside in one room of house inside in crate in my bed; other, please describe:
What percentage of time will the dog spend inside the house? %
Will your new pet be allowed on the furniture? Yes No
Have you ever had a serious behavior problem with a previous dog? Yes No
If so, please describe:
Do you have a doggie door?  Yes No
If not, and if it would work better, would you consider installing a doggie door?  Yes No
Have you always kept an ID tag (other than a rabies tag) bearing your phone number on your pets? Yes No
Are you willing to keep a collar and ID tag on all of your pets including a new dog at all times? Yes No
Under what circumstances do you think it is OK to leave a dog outside alone and unsupervised in an unfenced area?  in a quiet subdivision  on a lot of acreage  in a rural area  when I know they are trained to come back  none
What circumstances, in your mind, justify giving a dog up?  moving  new baby  not getting along with other pets  divorce  getting out of fence  behavioral problems  children lost interest  if it gets too big  too time consuming  shedding  allergies  housebreaking problems  medical problems  aggressive behavior  other - please explain:
Have you ever given a dog up or had a dog for a brief period of time and it didn't work out? Yes No
If so, please explain the circumstances and what happened to it: 
Have you ever looked at or applied for a pet with another rescue group? Yes No
If so, how long ago? Did you adopt? Please explain:
If you are unable to keep your dog for any reason at any time will you return the dog to us? Yes No
If you date or marry someone who does not like or want your pets, what would you do?
If your pet later develops a medical problem that becomes expensive, what would you do?  Find another home for him  Pay whatever it takes  Have him put to sleep  Give him to a rescue group or shelter  other - please explain:
If your pet develops a frequent urination problem at the age of 12 and can't hold it when left alone, what would you do?  Have him put to sleep since he is older  Babygate him in where flooring is not carpeted  Give him to a rescue group or shelter  Put in a doggie door  other - please explain:
If you are considering a long-haired breed, how often would the dog be groomed?
Would he get haircuts? Yes NoWould you do it yourself? Yes NoHave a groomer do it? Yes No
What type of food will you feed?  something from the grocery store  premium food from a pet supply store
Brand name:
Has a dog or puppy died on your premises in the last 6 months of distemper, parvo or unknown causes? Yes No
Please list the names, addresses and phone numbers of 2 personal references:
How did you hear about Chihuahua Rescue of Georgia?  website  newspaper  word of mouth  radio  at an adoption day  other - please specify:
Typing your name below will serve as legal signature.

By signing below, I am attesting to the truthfulness of my answers. Falsification of any of the above information will be grounds for disallowing the adoption of rescue dog and possible removal of said dog from my home. Applicant must be 21 years of age or older. Chihuahua Rescue of Georgia reserves the right to refuse any applicant.

 

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